This Week in JAMAFREE

MUSIC THERAPY, ANXIETY, AND SEDATIVE USE

Patients receiving mechanical ventilation experience significant levels of anxiety. In a multicenter randomized trial that enrolled 373 patients receiving mechanical ventilatory support, Chlan and colleagues assessed the effects of listening to music that was self-initiated and patient-directed on anxiety and the intensity and frequency of sedative exposure. The authors found that patient-directed music resulted in greater reductions in anxiety and sedation intensity than usual care but not compared with noise-cancelling headphones and greater reduction in sedation frequency than either usual care or noise-cancelling headphones. In an editorial, Azoulay and colleagues discuss the potential of music therapy to reduce anxiety in critically ill, mechanically ventilated patients.

INFLAMMATORY BIOMARKERS AND EXACERBATIONS OF COPD

Some patients with stable chronic obstructive pulmonary disease (COPD) have elevated levels of inflammatory biomarkers. In a prospective cohort of 6574 patients with COPD, Thomsen and colleagues found that simultaneously elevated levels of C-reactive protein (≥3 mg/L) and fibrinogen (≥14 μmol/L) and an elevated leukocyte count (≥9 × 109/L) were associated with an increased risk of a COPD exacerbation. In an editorial, Mador and Sethi discuss the identification of patients at high risk of COPD exacerbations.

MATERNAL OBESITY AND RISK OF PRETERM DELIVERY

In an analysis of 1992-2010 data from nearly 1.6 million singleton pregnancies in Sweden, Cnattingius and colleagues found that maternal overweight and obesity during early pregnancy were associated with increased risks of preterm delivery, particularly extreme preterm deliveries at 22 to 27 weeks' gestation.

HEALTH OUTCOMES IN ADULT CHILDHOOD CANCER SURVIVORS

Adult survivors of childhood cancer are at risk of treatment-related adverse health outcomes. Hudson and colleagues assessed the general health status and age-specific cumulative prevalence of adverse outcomes by organ system in a cohort of 1713 long-term survivors of childhood cancer. The authors found that the percentage of survivors with 1 or more chronic health conditions was very high, reaching 95% at age 45 years.

CLINICIAN'S CORNER

JAMA Clinical Challenge

A previously healthy 63-year-old man is seen in the emergency department with ptosis, limited ocular motility, and rapidly decreasing vision. Serum glucose is 690 mg/dL. Maxillofacial computed tomography imaging reveals sinusitis and orbital stranding. What would you do next?

EDITORIAL

A PIECE OF MY MIND

“High-functioning teams create structures—like daily huddles—that ensure that all relevant patient information is incorporated into the treatment plan and shared with all team members who ‘touch’ the patient.” From “The Columbo Phenomenon.”

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